Gon Y, Sakaguchi M, Takasugi J, Kawano T, Kanki H, Watanabe A, Oyama N, Terasaki Y, Sasaki T, Mochizuki H
Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
Eur J Neurol. 2017 Mar;24(3):503-508. doi: 10.1111/ene.13234. Epub 2016 Dec 27.
Cancer patients with cryptogenic stroke often have high plasma D-dimer levels and lesions in multiple vascular regions. Hence, if patients with cryptogenic stroke display such characteristics, occult cancer could be predicted. This study aimed to investigate the clinical characteristics of cryptogenic stroke as the first manifestation of occult cancer and to determine whether plasma D-dimer levels and lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke.
Between January 2006 and October 2015, data on 1225 patients with acute ischaemic stroke were extracted from the stroke database of Osaka University Hospital. Among them, 184 patients were classified as having cryptogenic stroke, and 120 patients without a diagnosis of cancer at stroke onset were identified. Clinical variables were analyzed between cryptogenic stroke patients with and without occult cancer.
Among 120 cryptogenic stroke patients without a diagnosis of cancer, 12 patients had occult cancer. The body mass index, hemoglobin levels and albumin levels were lower; plasma D-dimer and high-sensitivity C-reactive protein levels were higher; and lesions in multiple vascular regions were more common in patients with than in those without occult cancer. Multiple logistic regression analysis revealed that plasma D-dimer levels (odds ratio, 3.48; 95% confidence interval, 1.68-8.33; P = 0.002) and lesions in multiple vascular regions (odds ratio, 7.40; 95% confidence interval, 1.70-39.45; P = 0.01) independently predicted occult cancer.
High plasma D-dimer levels and lesions in multiple vascular regions can be used to predict occult cancer in patients with cryptogenic stroke.
隐源性卒中的癌症患者通常血浆D - 二聚体水平较高且存在多个血管区域的病变。因此，如果隐源性卒中患者表现出这些特征，可能提示存在隐匿性癌症。本研究旨在调查以隐匿性癌症的首发表现形式出现的隐源性卒中的临床特征，并确定血浆D - 二聚体水平和多个血管区域的病变是否能够预测隐源性卒中患者的隐匿性癌症。
2006年1月至2015年10月期间，从大阪大学医院的卒中数据库中提取了1225例急性缺血性卒中患者的数据。其中，184例患者被分类为隐源性卒中，且确定了120例在卒中发作时未诊断出癌症的患者。对有或无隐匿性癌症的隐源性卒中患者的临床变量进行了分析。
在120例未诊断出癌症的隐源性卒中患者中，有12例存在隐匿性癌症。与无隐匿性癌症的患者相比，有隐匿性癌症的患者体重指数、血红蛋白水平和白蛋白水平较低；血浆D - 二聚体和高敏C反应蛋白水平较高；多个血管区域的病变更常见。多因素logistic回归分析显示，血浆D - 二聚体水平（比值比，3.48；95%置信区间，1.68 - 8.33；P = 0.002）和多个血管区域的病变（比值比，7.40；95%置信区间，1.70 - 39.45；P = 0.01）可独立预测隐匿性癌症。
高血浆D - 二聚体水平和多个血管区域的病变可用于预测隐源性卒中患者的隐匿性癌症。
